[Recurrent orchiepididymitis, 6 months after likely miliary tuberculosis].
OBJECTIVE: To underscore the difficulty and importance of early diagnosis in tuberculous epididymo-orchitis. METHODS: Herein we describe a male patient with a history of fever for a long period, constitutional symptoms and retinal exudates that had been diagnosed and treated as systemic candidiasis instead of miliary tuberculosis. Six years later the patient presented with acute epididymo-orchitis. One year thereafter he developed contralateral epididymo-orchitis with a more torpid course. The patient did not respond to conventional treatment. Sterile pus was detected in urine; cultures and bacilli studies were negative. Testicular US findings were compatible with the condition and disclosed an abscessed area which was functioned and the diagnosis was made. RESULTS: The patient was treated with pirazinamide for two months and isoniacid and rifampicin for 12 months. However, the patient developed sterility. CONCLUSIONS: Tuberculous epididymo-orchitis can present acutely and can be confused with infection from other more common pathogens, or subacutely and confused with tumors. In many cases there is no previous patient or family history and chest x-ray, bacilloscopies and cultures can be negative. Tuberculosis must be considered due to its increasing incidence. US-guided fine needle punction-aspiration biopsy is very useful for diagnosis, which has to be made as early as possible to avoid sterility.